SOMATIC SYMPTOM ILLNESSES
• Three central features
• Physical complaints suggest major medical illness but have no demonstrable
organic basis
• Psychological factors and conflicts seem important in initiating, exacerbating,
maintaining symptoms
• Symptoms or magnified health concerns are not under patient’s conscious
control
• Is the following statement true or false?
• A patient with a somatic symptom illness is able to voluntarily control the
symptoms.
TYPES OF SOMATIC SYMPTOM ILLNESSES #1
1. Somatic symptom illness: multiple physical symptoms—combination of
pain, GI, sexual, pseudo-neurologic symptoms
2. Conversion disorder: exhibits voluntary sensory or motor deficits
associated with psychological factors that begin and ends rapidly; typically
involves significant functional impairment; “la belle indifference”
• Include blindness, paralysis, seizures, deafness, or abnormal motor
movements.
3. Pain disorder: pain unrelieved by analgesics; psychological factors
influencing onset, severity, exacerbation, maintenance ( Hypochondriasis)
RELATED DISORDERS
• Malingering: intentional false or grossly exaggerated symptoms; external
incentives as motivation
• Factitious disorder: intentional symptoms to gain attention (Munchausen’s
syndrome = imposed upon self)
• Munchausen’s syndrome by proxy = imposed upon others
• Janny and Bodie
Body Dysmorphic:
Preoccupation with an imagined defect in appearance- Octo mom
• Slight anomaly has an excessive response
• May avoid social or work leading to social isolation
• Low self esteem , shame and worthless ness may lead to Suicide.
TYPES OF DISSOCIATIVE DISORDERS
• Dissociative amnesia
•
One or more episodes of inability to recall important personal information,
usually of a traumatic or stressful nature
Sudden, unexpected travel away from home or one’s customary place of
• Dissociative fugue
•
work, with an inability to recall one’s past
1. Psychosocial theories
• Internalization
ETIOLOGY
• Primary gains: direct external benefits of being sick provide relief of anxiety, conflict, distress
• Secondary gains: person receives internal or personal benefits from others because one is sick.
2. Biologic theories
• change the brain caused by prolonged stress or trauma by altering individuals’ perception and
interpretations of bodily function.
3. Behavioral-Learned to use somatic symptoms to communicate helplessness and manipulate others.
4. Cognitive- misinterpret the meaning of body functions and become overly alarmed
SOMATIC SYMPTOM ILLNESSES AND NURSING
PROCESS APPLIC ATION
• Assessment
• Investigation of physical health status; screening
• History: usually detailed medical history; distress about health status (except
patient with conversion disorder who displays la belle indifference)
• General appearance, motor behavior
• Mood, Affect: labile; exaggerated emotions
• *Is the following statement true or false?
• A patient with a Factitious disorder develops symptoms primarily for
attention.
SOMATIC SYMPTOM ILLNESSES AND NURSING
PROCESS APPLIC ATION
• Data analysis/nursing diagnoses
• Outcome identification
• Identify relationship between stress and physical symptoms
• Verbally express emotions/feelings
• Establish and follow a daily routine
• Demonstrate alternate ways to deal with stress, anxiety, and other
feelings
• Demonstrate healthy behaviors regarding rest, activity, and nutritional
intake
SOMATIC SYMPTOM ILLNESSES AND NURSING
PROCESS APPLIC ATION
• Intervention
• Provide health teaching: improved health behaviors
• Help express emotions: journaling; limiting time spent on physical complaints
• Teach coping strategies
• Emotion-focused coping strategies
• Problem-focused coping strategies
• Discharge planning : Symptom management, improvement in quality of life
• SSRI
• Pain clinic referral for disorder
• Involvement in therapy groups/support groups